Changes at Mission Control notwithstanding, the new Cancer Moonshot is ready for liftoff, says Danielle Carnival, coordinator of the White House cancer initiative.
“I hope that you and your readers are comforted and reassured as to where the president’s priorities are,” said Carnival, senior advisor to the director of the White House Office of Science and Technology Policy. “And with new leadership to come, I know that they will pick right up and continue to move that forward.”
Carnival spoke with The Cancer Letter Feb. 15, one day before President Joe Biden appointed Alondra Nelson and Francis Collins to step in as leaders of the White House science agenda, replacing Eric Lander, who stepped down after findings that he mistreated his staff members.
Nelson, currently OSTP’s deputy director for science and society, will perform the duties of the OSTP director. Collins, the immediate past director of NIH, will perform the duties of science advisor to the president and co-chair of the President’s Council of Advisors on Science and Technology until permanent leadership is nominated and confirmed.
“These appointments will allow OSTP and the President’s Science and Technology agenda to move seamlessly forward under proven leadership,” the White House said in a statement Feb. 16.
Biden’s Moonshot 2.0—launched Feb. 2 with the kind of fanfare that recalls the pomp of pre-pandemic White House functions—promises to build on the advances in cancer research and informatics started in 2016 (The Cancer Letter, Feb. 4, 2022; To The Moon).
Less than a week after the announcement, OSTP Director Lander resigned following news reports of an internal White House investigation finding that he bullied and demeaned his subordinates (The Cancer Letter, Feb. 11, 2022). Lander’s resignation is effective Feb. 18.
Carnival said the White House doesn’t yet have a budget request for Cancer Moonshot 2.0. “We are not putting a number on that at this point,” she said.
Biden’s science agenda and the OSTP isn’t bereft of leadership, White House officials said.
“It is worth noting that I am here,” Carnival said. “And we have incredible leadership across OSTP on the major issues, including pandemic preparedness and many others that have not stopped, even given the coming resignation of Dr. Lander.”
This second phase of the Cancer Moonshot will convene a pan-government presidential Cancer Cabinet to move on several fronts in oncology—to be exact, seven “pillars” to: diagnose cancer sooner, prevent cancer, address inequities, target the right treatments to the right patients, speed progress against the most deadly and rare cancers, including childhood cancers, support patients, caregivers, and survivors, and learn from all patients.
“Some of them are very research-focused, like developing new approaches to treat some of these rare or deadliest cancers, or knowing and better understanding how to target treatments to the right patients,” Carnival said. “But there’s a lot of interesting science and research advancements that are going to be needed in other pillars, like in the area of prevention and early detection and learning from more patients’ experiences.”
NCI Director Ned Sharpless would have a seat in the Cancer Cabinet, alongside heads of other HHS agencies, and the institute will “be an important part of how we make progress towards ending cancer as we know it,” Carnival said.
Biden’s proposed ARPA-H, or Advanced Research Projects Agency for Health, too, would play a role in cancer research, in tandem with the moonshot.
“We have seen pretty strong bipartisan support for the bold vision that the president laid out in ARPA-H and do expect it to move forward,” Carnival said. “I think there is an important intersection between the Cancer Moonshot and realizing the vision of ARPA-H, the promise for ARPA-H to really breakthrough where we haven’t found answers.
“With this new agency, the president has really put forward something that, like I said, I truly believe will make a difference in the fight against cancer and will also have an impact on other diseases.”
As OSTP plans the first Cancer Cabinet meeting, the White House is focused on making immediate, measurable progress on the Moonshot 2.0’s primary goal—to reduce the age-adjusted death rate from cancer by at least 50% within the next 25 years.
“Setting a goal out 25 years could sound to some like we’re pushing accountability down the road,” Carnival said. “But as you know, to reach that 50% decrease, we need a year-over-year decrease in the death rate by cancer starting now.
“And so, there is an urgency to this. We will be convening—under my and many cabinet members’ leadership—a Cancer Cabinet and working across the government to find new programs, new research, grant opportunities, and new collaboration in order to achieve that.”
Carnival, who has a PhD in neuroscience, served as chief of staff and senior policy director for the 2016-2017 White House Cancer Moonshot Task Force. Subsequently, she served as vice president for the Biden Cancer Initiative.
She spoke with Matthew Ong, associate editor of The Cancer Letter.
Matthew Ong: Many of us in oncology are looking forward to the progress that can be made through President Biden’s recommitment to the Cancer Moonshot. As coordinator, what is your vision for carrying out the objectives of Moonshot 2.0?
Danielle Carnival: Thank you for that question and for the excitement around the vision that President Biden and the first lady and the vice president laid out two weeks ago. I think in really bringing a presidential priority to this and bringing back a White House focus, what we are most excited about bringing to this is really an all-of-government approach.
The work that was started with the Cancer Moonshot in 2016 has seen a lot of fruits and results from the best ideas that could be implemented at that time, both by the government and by many, many private sector foundations, healthcare providers, patient advocacy groups, and others.
And what I’m most looking forward to is really learning from what has been accomplished over the last five years and where we are in the research and science to catapult us towards the goals that the president laid out to decrease the age-adjusted death rate by cancer by 50% over 25 years, and by improving the experience of people living with and surviving cancer in their families and loved ones and caregivers.
How would you describe your role at the OSTP? As coordinator, what are your duties in relation to the President’s Cancer Cabinet?
DC: As you can imagine, these bold new goals are going to take a lot of work and coordination across the administration.
And so, my role is to make sure that the vision that the president laid out, that is at least twofold—one on the federal government side, that we have our ducks in a row and are really moving forward with an agenda that starts to deliver on that goal immediately. Setting a goal out 25 years could sound to some like we’re pushing accountability down the road. But as you know, to reach that 50% decrease, we need a year-over-year decrease in the death rate by cancer starting now.
And so, there is an urgency to this. We will be convening—under my and many cabinet members’ leadership—a Cancer Cabinet and working across the government to find new programs, new research, grant opportunities, and new collaboration in order to achieve that.
The other part, which is no less important, is making sure that we are engaging with and hearing the best ideas and potential new actions from folks most directly impacted by cancer, people living with cancer, survivors, through an extensive engagement effort, and to working with the private sector and foundations and healthcare providers and others who want to be a part of achieving this goal.
And really between the federal government and that private side, really accelerating our work across these seven pillars that the president laid out for us.
What’s the latest on the formation of the Cancer Cabinet? Is OSTP leading the charge on convening the cabinet as well?
DC: We are definitely leading the charge on coordinating and making sure that it comes together, as mentioned in the fact sheet that accompanied the president’s announcement. There are a number of departments and agencies and White House offices involved. So, there is a lot of leadership being brought to this issue as required by what the president set out.
We’ve already brought together a deputy level meeting to start to get the coordination and collaborative pieces in place. And we look forward to having a principals-level meeting very soon to really set the agenda for 2022 and beyond for the Cancer Moonshot.
In terms of federal funding, what do you think it would take for the Cancer Moonshot to effectively achieve its goals according to schedule?
DC: We are not putting a number on that at this point, since, one, the Cancer Moonshot funding, at NCI in particular, that was included in the 21st Century Cures Act that President Obama signed in December right before the end of the administration, is carried through as long as the appropriations, like they have for the last six years, meet the expectation of funding that part of the 21st Century Cures bill—that carries through to the next fiscal year.
So, we know that there is continued support for the great ideas that came about in 2016. And what we’re really looking to do through the Cancer Cabinet process is pull together new ideas, ways we can expand not only the research side and the development of new ways to prevent, detect, and treat cancer, but also making sure that those tools reach more Americans now.
For one example, the president and first lady put out a call to action around cancer screening and early detection. We know that Americans have missed, because of the pandemic, more than 9.5 million screenings. We know based on data and history, what that will mean for people being diagnosed later than they otherwise would have, and so, we’re putting a lot of urgency around that.
And I just want to stress the fact that this is no less a research effort than it was last time, but it is even more an effort to make sure that everyone’s benefiting from the tools we have today.
What is the role of the NCI director of the Moonshot? And is NCI and its National Cancer Program limited to leadership of the research arm of the cabinet within the Moonshot?
DC: Well, the NCI director has a seat at the Cancer Cabinet table, along with the heads of departments across the cabinet, and along with other parts of HHS, the Department of Health and Human Services like the FDA, and the CDC, and CMS, and the NIH.
The NCI is a premier research funding organization and the largest funder of research from the federal government. So, of course, they have an important seat at the table, have been involved in the development of these ideas, have shown leadership on some of the early work, especially around delivering on the agreement to have bilateral convening between the U.S. and the U.K. around what’s possible together.
Dr. Ned Sharpless, the director of NCI and his team, along with their counterparts in the U.K., led a fantastic meeting last November that put together a set of recommendations of how we could work together. And those recommendations are now being socialized and we’re looking at next steps as how to move that forward.
So, that’s just one example. But the NCI is an important part of how we make progress towards ending cancer as we know it.
What are OSTP’s leadership transition plans after Dr. Eric Lander steps down? Who will lead President Biden’s science agenda and the overarching mission for the moonshot?
DC: I don’t have any personnel updates to share today, but I know that it is a priority for the president to make sure that there is strong leadership for his scientific agenda.
I can speak to the Cancer Moonshot where, given my role in coordinating this work, I am continuing to move it forward and look forward to having a Cancer Cabinet meeting very soon. And we’ll be delighted to work with whatever leadership comes in to lead the broader scientific agenda and to help prioritize the progress against cancer for this administration.
Was Dr. Lander the lead visionary on the moonshot and ARPA-H? Also, how does the White House and the OSTP plan to recapture the trust of the scientific community and the public after results of the internal investigation were announced or were revealed last week?
DC: I don’t have anything to add on the reporting that has been done on Eric Lander in particular. I think what’s important here is what the president believes and prioritizes and the scientific community’s advancement around human health, climate change, and the promise of technology—and many other aspects of OSTP priorities have been priorities for the president for decades.
So, I hope that you and your readers are comforted and reassured as to where the president’s priorities are. And with new leadership to come, I know that they will pick right up and continue to move that forward.
And it is worth noting that I am here and we have incredible leadership across OSTP on the major issues, including pandemic preparedness and many others that have not stopped, even given the coming resignation of Dr. Lander.
Where does ARPA-H stand at the moment? Do you have a sense of whether it will receive funding in fiscal year 2022? And do you expect the work of the Moonshot to dovetail with the mission of ARPA-H?
DC: It’s a great question. On the first part, yes, we have seen pretty strong bipartisan support for the bold vision that the president laid out in ARPA-H and do expect it to move forward. And you heard the president in the speech he gave in reigniting the moonshot, he put pressure and really emphasized the importance of realizing this new agency that will drive breakthroughs to prevent, detect, and treat diseases including cancer, Alzheimer’s, diabetes and others.
There’s a lot of interesting science and research advancements that are going to be needed in other pillars, like in the area of prevention and early detection and learning from more patients’ experiences. And not all of that is on the agenda of ARPA-H, but I see a lot of potential for making progress on the Cancer Moonshot through ARPA-H.
I think there is an important intersection between the Cancer Moonshot and realizing the vision of ARPA-H, the promise for ARPA-H to really break through where we haven’t found answers. NIH, federal investment in biomedical research has delivered everything we have today. Many of the advancements that we have today to treat human disease and maintain the health of Americans and those around the world, but we haven’t solved everything.
With this new agency, the president has really put forward something that, like I said, I truly believe will make a difference in the fight against cancer and will also have an impact on other diseases. So, it is an important part of us realizing the president’s vision, but not the only—obviously, as I mentioned, there are many pillars that the president laid out—seven pillars around how we want to make progress to end cancer as we know it.
Some of them are very research focused, like developing new approaches to treat some of these rare or deadliest cancers, or knowing and better understanding how to target treatments to the right patients.
But there’s a lot of interesting science and research advancements that are going to be needed in other pillars, like in the area of prevention and early detection and learning from more patients’ experiences. And not all of that is on the agenda of ARPA-H, but I see a lot of potential for making progress on the Cancer Moonshot through ARPA-H.
You’ve been working with the cancer community for many years now—what can academic cancer centers, life sciences companies, and cancer organizations expect to hear from you and the OSTP with the reignited moonshot?
DC: Two things. One, I hope they heard a very committed president to this issue and a very clear vision, new goals, and like I said, these seven pillars that identify the ways in which we know cancer today. And if we make progress on those, we can make progress towards ending cancer as we know it.
What I hope that does is give us a common agenda to choose where we can make a difference for people facing a cancer diagnosis and to do all we can to accelerate the progress in areas that we can contribute to.
The other thing I want to mention is on the day of the reignition of the moonshot, we did launch a webpage, whitehouse.gov/cancermoonshot, where anyone can interact with the ongoing work.
We held a number of engagement sessions in the fall, gaining perspectives from people living with cancer, and survivors, leading researchers, clinicians, companies, and others. We are going to continue those, but the most direct way to share ideas and perspectives and new actions that outside organizations and companies want to take is through that website.
Is the White House working on building a cancer coalition within the community?
DC: The only body we’ve created at this point is the Cancer Cabinet, which is an internal-to-government way that the Biden-Harris administration is going to organize around this priority and really identify new ways to deliver on what the president has outlined and to make progress towards these goals.
You will remember, we had a Blue Ribbon Panel that NCI put together around the original moonshot to identify mostly scientific research priorities for the Cancer Moonshot in 2016. There aren’t any plans to do that at this point, but maybe in the future.
Did we miss anything?
DC: The one thing I will add, because in the midst of technical goals and seven pillars of how we want to make progress, I think what I am still reflecting on is sitting in the room a week and a half ago and hearing the personal experience, the personal understanding, and the personal commitment from three individuals who happened to be the president, the first lady, and the vice president.
And I just hope that in the midst of all of the work that needs to get done to make progress on these goals, that we can all sit with the words that we heard from them and really know and understand how truly committed to this they are, how personal it is for them, and how all of us can be a part of making this progress that impacts millions of Americans and many, many millions more across the world.
